Provider Demographics
NPI:1639214323
Name:MILLS, MARILYN KAY (LCMHC)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:KAY
Last Name:MILLS
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:KAY
Other - Last Name:SHANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:138 BROAD ST
Mailing Address - Street 2:DOWNSTAIRS
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3328
Mailing Address - Country:US
Mailing Address - Phone:860-347-7320
Mailing Address - Fax:
Practice Address - Street 1:138 BROAD ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3328
Practice Address - Country:US
Practice Address - Phone:860-347-7320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT68000187101YM0800X
CT001548101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional